In Brain News

Today, for the first time in the UK, brain cancer patients are starting to receive treatment with Novalis Tx radiosurgery.

It is estimated that 150 brain tumour patients will benefit from this new brain tumour treatment in its first year of operation at the new £17m Clatterbridge Cancer Centre adjacent to the Walton Centre at Liverpool’s Aintree Hospital.

Much like Gamma Knife brain tumour treatment which already exists at a handful of locations across the country, this Novalis Tx radiosurgery gives the chance of a cure to those with otherwise inoperable brain tumours. It also  offers the possibility to perform precise painless treatment to brain tumours in a single patient visit. Furthermore the technology enables clinicians to adopt an approach where they can ‘control’ brain tumours without risky invasive brain surgery.

Radiosurgery makes it possible for doctors to treat patients with tumours virtually anywhere in the body in just a single session. It combines a ‘sat nav’ like targeting system and powerful treatment beams to destroy cancerous cells and help to protect surrounding healthy tissue.

 

From what we gathered at the launch, this new technology at the Clatterbridge Cancer Centre will be used to treat a range of brain tumours, including those that are metastatic. From what we gather it does not look like the Novalis Tx, or other radiosurgical devices can be used for the treatment of Glioblastoma at this point in time.

This is by no means a magic bullet.

Of  the 120+ brain tumours that people can contract, you are most likely to have radiosurgery if you have an acoustic neuroma that is less than 3cm across. Radiosurgery can also be used for other brain tumours, including small secondary brain tumours, small pituitary adenomas. This brain tumour treatment is well suited to people who can’t have surgery due to other medical conditions and Haemangioblastomas that couldn’t be removed, were only partially removed, or came back after surgery.

Doctors also use this type of treatment for non cancerous conditions, such as ‘arteriovenous malformation’ (AVM).

It is also worth noting that specialists don’t recommend radiosurgery for larger brain tumours. It isn’t possible to get the same dose of radiotherapy throughout the treatment area with a large tumour.

Radiosurgery may also not be suitable if there are certain nerves running through the treatment area. The nerves could be given too much radiation. This could cause problems such as hearing loss, depending on the role of the affected nerves.

And our thoughts?

 

Well, the introduction of the Novalis Tx at the Clatterbridge Cancer Centre is more great news for brain tumour patients in the North West. To think that the wheels have been in motion on this long before the Government announced its additional investment into cancer treatment just shows the foresight of the Trusts, and that being able to act proactively and autonomously holds real benefits for patient outcomes. Naturally we feel that it’s a shame that every trust can’t push for novel brain cancer treatments, for which there is currently an unmet need in the UK.

 

However, with the snowballing uptake of this new technology we are hoping that brain tumour treatment and control of brain tumours with Novalis Tx, or indeed any other form of radiosurgery will be considered more readily for any patient in the UK for whom their doctor feels it is suitable.

 

Indeed, there is more good news on the horizon: Later this year Novalis Tx machines will become operational at two other specialist NHS cancer centres in Edinburgh and Manchester. This means stereotactic radiosurgery will be available, potentially, to brain tumour patients in nearly every major city in England and Scotland.

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Introduction

The Brain Tumour Data Dashboard lets you explore up -to-date, population level data about the brain tumours diagnosed in England between 2013 and 2015. Using the drop down menus on the left you can select different groups of patients to view in the charts below. In these charts the number of patients for every 100 diagnoses is displayed as images of people. Patients have been grouped by date of diagnosis, type of tumour, age, gender, and region in England.

For each group of patients you can explore the different routes to diagnosis, the proportion of those who received chemotherapy or radiotherapy, as well as the survival of the patients within each group. For more information about what these metrics mean please see the glossary.

How to use

  1. Select the year of diagnosis using the drop down menu.
  2. Select your patient group of interest from the four drop down menus in the following order:
    1. Tumour group
    2. Age at diagnosis
    3. Region of England
    4. Gender of patient
  3. To view a second chart to compare different groups of patients, click the ‘compare’ button.The second chart will appear below the first chart.

*Note that the tool is best used on a laptop or tablet rather than a mobile phone*

Unavailable data

Some of the data in these charts is not available.There are two main reasons for this:

  1. How the data has been grouped

If you cannot select a patient group from the drop down menus, the data is unavailable because of how the data has been organised.

Public Health England has grouped the data like a branching tree. The bottom of the tree contains all the patients with brain tumours, and then each branch divides the data by a certain characteristics, like age, or location of tumour. But the data is divided in an order, starting with location of the tumour (endocrine or brain), then by age, region, and gender. Age is at the start because it makes a bigger difference to survival rates and treatment rates than gender or region. Sometimes, after the data has been split by type of tumour and age, there is not enough data to be split again. This is because to protect patient confidentiality groups cannot contain less than 100 patients. Because some groups cannot be split further, you cannot create ‘totals’ for everyone by region or gender. For example, you cannot see results for all ages by region, or all brain tumours by gender. If these totals were calculated and released, it might be possible to identify patients, which is why Public Health England cannot release this data.

  1. Statistical reasons and data availability

If you can select a patient group from the chart menus, but the chart does not display, the data is unavailable for one of several reasons:

  1. Data is not yet available for the selected year from Public Health England.
  2. Data is not available because the data quality is too poor to release this statistic.
  3. Data is not available as the statistic is not appropriate for this group.
  4. Data is not available because the standard error of the estimate was greater than 20% and so the estimate has been supressed.

Up to date brain tumour data

Brain tumour data may influence the decisions you make about your care. Data also helps you understand the bigger picture, or landscape, in which you find yourself.

Brain tumour data and statistics influence the focus, and work of organisations like brainstrust. The information helps us to understand the scale and impact of the problems we are setting out to solve.

This tool helps you understand the landscape in which you find yourself having been diagnosed with a brain tumour. This landscape can be particularly tricky to navigate as there are many different types of brain tumour, all of which have a different impact.

The information you see represents the most up-to-date, official, population level brain tumour data available for England. Over time we will be adding to the brain tumour data available and publishing reports, with recommendations, as a result of what we learn from this data.

The data behind this content has come from Public Health England’s National Cancer Registration and Analysis Service (NCRAS) and is a direct result of the ‘Get Data Out’ project.

This project provides anonymised population level brain tumour data for public use in the form of standard output tables, accessible here: http://cancerdata.nhs.uk/standardoutput

Incidence

The number or rate (per head of population) of new cases of a disease diagnosed in a given population during a specified time period (usually a calendar year). The crude rate is the total number of cases divided by the mid-year population, usually expressed per 100,000 population.

Malignant

Malignant tumours which grow by invasion into surrounding tissues and have the ability to metastasise to distant sites

Mortality

The number or rate (per head of population) of deaths in a given population during a specified time period (usually a calendar year). The crude rate is the total number of deaths divided by the mid-year population, usually expressed per 100,000 population.

Non-malignant

Not cancerous. Non-malignant tumours may grow larger but do not spread to other parts of the body.

Survival

The length of time from the date of diagnosis for a disease, such as cancer, that patients diagnosed with the disease are still alive. In a clinical trial, measuring the survival is one way to see how well a new treatment works. Also called ‘overall survival’ or ‘OS’.

Routes to Diagnosis

Under the ‘Routes to Diagnosis’ tab in the Brain Tumour Data Dashboard, you can explore the ways patients have been diagnosed with brain tumours. There are many ways, or routes, for cancers to be diagnosed in the NHS. A ‘route to diagnosis’ is the series of events between a patient and the healthcare system that leads to a diagnosis of cancer. The routes include:

  1. Two Week Wait

Patients are urgently referred by their GP for suspected cancer via the Two Week Wait system and are seen by a specialist within 2 weeks where they are diagnosed.

  1. GP referral

Diagnosis via a GP referral includes routine and urgent referrals where the patient was not referred under the Two Week Wait system.

  1. Emergency Presentation

Cancers can be diagnosed via emergency situations such as via A&E, emergency GP referral, emergency transfer or emergency admission.

  1. Outpatient

Outpatient cancer diagnoses include diagnoses via an elective route which started with an outpatient appointment that is either a self-referral or consultant to consultant referral. (It does not include those under the Two Week Wait referral system).

  1. Inpatient elective

Diagnosis via an inpatient elective route is where diagnosis occurs after the patient has been admitted into secondary care from a waiting list, or where the admission is booked or planned.

  1. Death Certificate Only

Diagnoses made by Death Certificate Only are made where there is no more information about the cancer diagnosis other than the cancer related death notifications. The date of diagnosis is the same as that of the date of death.

  1. Unknown

For some patients with a cancer diagnosis, there is no relevant data available to understand the route to diagnosis.

 

More information

If any of the statistical terms in this section of the brainstrust website are hard to understand, we recommend looking them up here:

Cancer Research UK’s Cancer Statistics Explained

http://www.cancerresearchuk.org/health-professional/cancer-statistics/cancer-stats-explained/statistics-terminology-explained#heading-Seven

If you are looking for help understanding terms relating specifically to brain tumours, and treatment, then the brainstrust glossary is available here:

https://www.brainstrust.org.uk/advice-glossary.php